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10,845
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Education
September 1990 - September 1994
Publications
Publications (118)
We provide evidence that investor behavior is sensitive to two dimensions of subjective uncertainty concerning future asset values. Investors vary in the extent to which they attribute market uncertainty to (1) missing knowledge, skill, or information (epistemic uncertainty) and (2) chance or stochastic processes (aleatory uncertainty). Investors w...
Influenza vaccination rates are low. Working with a large US health system, we evaluated three health system-wide interventions using the electronic health record's patient portal to improve influenza vaccination rates. We performed a two-arm RCT with a nested factorial design within the treatment arm, randomizing patients to usual-care control (no...
Purpose
To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.
Design
Randomized, controlled trial.
Setting
Two health systems in the Northeastern US between September 2020 and March 2021.
Subjects
74,811 adults.
Interventions
Patients in the 19 intervention arms receive...
BACKGROUND
: Unnecessary testing and treatment of common conditions in older adults can lead to significant morbidity and mortality.
The primary objective of this study was to develop and pilot test a set of clinical decision support (CDS) alerts informed by social psychology to address overuse in three areas related to ambulatory care of older adu...
This study examines the portfolio allocation decisions of 80 business students in a computer-based investing simulation. Our goal was to better understand why investors spend so much time and money on actively managed mutual funds despite the fact that the vast majority of these funds are outperformed by passively managed index funds. Participants'...
Policymakers and business leaders often use peer comparison information—showing people how their behavior compares to that of their peers—to motivate a range of behaviors. Despite their widespread use, the potential impact of peer comparison interventions on recipients’ well-being is largely unknown. We conducted a 5-mo field experiment involving 1...
Background:
The CDC estimates that over 40% of Urgent Care visits are for acute respiratory infections (ARI), more than half involving inappropriate antibiotic prescriptions. Previous randomized trials in primary care clinics resulted in reductions in inappropriate antibiotic prescribing, but antibiotic stewardship interventions in telehealth have...
Background:
Inappropriate polypharmacy, prevalent among older patients, is associated with substantial harms.
Objective:
To develop measures of high-risk polypharmacy and pilot test novel electronic health record (EHR)-based nudges grounded in behavioral science to promote deprescribing.
Design:
We developed and validated seven measures, then...
Background
Overtesting and treatment of older patients is common and may lead to harms. The Choosing Wisely campaign has provided recommendations to reduce overtesting and overtreatment of older adults. Behavioral economics-informed interventions embedded within the electronic health record (EHR) have been shown to reduce overuse in several areas....
Background
High levels of opioid prescribing in the United States has resulted in an alarming trend in opioid-related harms. The objective of Trial 2 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-2) is to dampen the intensity and frequency of opioid prescribing in accordance with the Centers for Di...
Background:
Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health syst...
Background
Adult influenza vaccination rates are low. Tailored patient reminders might raise rates.
Objective
Evaluate impact of a health system’s patient portal reminders: (1) tailored to patient characteristics and (2) incorporating behavioral science strategies, on influenza vaccination rates among adults.
Design
Pragmatic 6-arm randomized tri...
Objectives:
In a large health system, we evaluated the effectiveness of electronic health record patient portal reminders in increasing pediatric influenza vaccination rates.
Methods:
We conducted an intention-to-treat randomized clinical trial of 22 046 children from 6 months to <18 years of age in 53 primary care practices. Patients (or parent...
High acceptance of coronavirus disease 2019 (COVID-19) vaccines is instrumental to ending the pandemic. Vaccine acceptance by subgroups of the population depends on their trust in COVID-19 vaccines. We surveyed a probability-based internet panel of 7832 adults from December 23, 2020–January 19, 2021 about their likelihood of getting a COVID-19 vacc...
Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment ( N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findin...
People differ in their lay theories about how and why the financial well-being of individuals changes over time or varies between individuals. We introduce a measure of Causal Attributions of Financial Uncertainty—the CAFU scale—and find that such attributions can be reliably described along three distinct dimensions, respectively capturing the ext...
Background
There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm. Despite clinical guidelines and education, prescribing continues at a higher rate than before the opioids crisis. The objective of trial 1 of the Application of Economics & Social psychology to improve Opioid Pres...
Investors’ attributions of uncertainty can be perturbed by the format in which historical information is presented. When prompted to view stock market uncertainty as higher in epistemicness (knowability), investors become more sensitive to their available information when choosing whether or not to invest, and are more likely to reduce uncertainty...
People differ in their beliefs about how and why the financial well-being of individuals changes over time. We find that these lay theories can be reliably described along three independent dimensions, respectively capturing the extent to which changes in financial well-being are perceived to be: (1) knowable and within individuals’ control due to...
Background
Uncontrolled hypertension contributes to disparities in cardiovascular outcomes. Patient intervention strategies informed by behavioral economics and social psychology could improve blood pressure (BP) control in disadvantaged minority populations.
Objective
To assess the impact on BP control of an intervention combining short-term fina...
We propose a new conceptual framework for behavioral policy design that we call choice architecture 2.0. We argue that in addition to considering how different choice environments affect decisions (as in conventional choice architecture), choice architects should also be aware of the implicit interaction taking place between the targets of the choi...
This article reviews research from several behavioral disciplines to derive strategies for prompting people to perform behaviors that are individually costly and provide negligible individual or social benefits but are meaningful when performed by a large number of individuals. Whereas the term social influence encompasses all the ways in which peo...
We propose that an important determinant of judged confidence is the evaluation of evidence that is unknown or missing, and overconfidence is often driven by the neglect of unknowns. We contrast this account with prior research suggesting that overconfidence is due to biased processing of known evidence in favor of a focal hypothesis. In Study 1, w...
Inappropriate antibiotic prescribing contributes to antibiotic resistance and leads to adverse events.¹ A cluster-randomized trial of 3 behavioral interventions² intended to reduce inappropriate prescribing found that 2 of the 3 interventions were effective.³ This study examines the persistence of effects 12 months after stopping the interventions.
Government agencies around the world have begun to embrace the use of behavioural policy interventions (such as the strategic use of default options), which has inspired vigorous public discussion about the ethics of their use. Since any feasible policy requires some measure of public support, understanding when people find behavioural policy inter...
People view uncertain events as knowable in principle (epistemic uncertainty), as fundamentally random (aleatory uncertainty), or as some mixture of the two. We show that people make more extreme probability judgments (i.e., closer to 0 or 1) for events they view as entailing more epistemic uncertainty and less aleatory uncertainty. We demonstrate...
Background
Clinicians frequently prescribe antibiotics inappropriately for acute respiratory infections (ARIs). Our objective was to test information technology-enabled behavioral interventions to reduce inappropriate antibiotic prescribing for ARIs in a randomized controlled pilot test trial. Methods
Primary care clinicians were randomized in a 2...
We argue that people intuitively distinguish epistemic (knowable) uncertainty from aleatory (random) uncertainty and show that the relative salience of these dimensions is reflected in natural language use. We hypothesize that confidence statements (e.g., "I am fairly confident," "I am 90% sure," "I am reasonably certain") communicate a subjective...
Objective:
The aim of this study was to determine whether exposure to data from a risk calculator influences surgeons' assessments of risk and in turn, their decisions to operate.
Background:
Little is known about how risk calculators inform clinical judgment and decision-making.
Methods:
We asked a national sample of surgeons to assess the ri...
Objective:
To determine how surgeons' perceptions of treatment risks and benefits influence their decisions to operate.
Background:
Little is known about what makes one surgeon choose to operate on a patient and another chooses not to operate.
Methods:
Using an online study, we presented a national sample of surgeons (N = 767) with four detail...
Importance
Interventions based on behavioral science might reduce inappropriate antibiotic prescribing.Objective
To assess effects of behavioral interventions and rates of inappropriate (not guideline-concordant) antibiotic prescribing during ambulatory visits for acute respiratory tract infections.Design, Setting, and Participants
Cluster rando...
We explore the relationship between indecisiveness and impulsivity using a variety of individual difference measures for each construct. We observe a positive, rather than negative, correlation between traditional measures of indecisiveness and impulsivity. Further analysis demonstrates that standard measures of indecisiveness are positively correl...
This chapter focuses on studies of decision making under risk. It examines how insights from studies of risky choice can be extended more generally to uncertainty. An overview of decision making behavior under risk follows. The chapter first retreats from the field to the laboratory, setting aside for the moment the richness of naturalistic environ...
Background:
Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse.
Objective:
The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among pri...
Clinicians make many patient care decisions each day. The cumulative cognitive demand of these decisions may erode clinicians’ abilities to resist making potentially inappropriate choices. Psychologists, who refer to the erosion of self-control after making repeated decisions as decision fatigue,¹,2 have found evidence that it affects nonmedical pr...
Uncertainty pervades most aspects of life. From selecting a new technology to choosing a career, decision makers rarely know in advance the exact outcomes of their decisions. Whereas the consequences of decisions in standard decision theory are explicitly described (the decision from description (DFD) paradigm), the consequences of decisions in the...
Importance:
"Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice.
Objective:
To investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the...
Background: Fatigue and stress may deplete clinicians’ capacity to resist prescribing antibiotics for acute respiratory infections (ARIs). We hypothesized that primary care clinicians would be less likely to prescribe antibiotics for ARIs at the beginning and more likely to prescribe antibiotics for ARIs at the end of clinic sessions.
Methods: We...
A fundamental debate in social sciences concerns how individual judgments and choices, resulting from psychological mechanisms, are manifested in collective economic behavior. Economists emphasize the capacity of markets to aggregate information distributed among traders into rational equilibrium prices. However, psychologists have identified perva...
Background:
Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for...
The authors propose that attempts to increase consumers’ objective
knowledge (OK) regarding financial instruments can deter willingness to
invest when such attempts diminish consumers’ subjective knowledge
(SK). In four studies, the authors use different SK manipulations and
investment products to show that investment decisions are influenced by
SK...
Published as "Beware of black swans: Taking stock of the description–experience gap in decision under uncertainty," Marketing Letters, Springer, vol. 25(3), pages 269-280, September.
Uncertainty pervades most aspects of life. From selecting a new technology to choosing a career, decision makers often ignore the outcomes of their decisions. In the...
People often hold extreme political attitudes about complex policies. We hypothesized that people typically know less about such policies than they think they do (the illusion of explanatory depth) and that polarized attitudes are enabled by simplistic causal models. Asking people to explain policies in detail both undermined the illusion of explan...
Despite a revolution in therapeutics, the ability to control chronic diseases remains elusive. We present here a conceptual model of the potential role of behavioral tools in chronic disease control. Clinicians implicitly accept the assumption that patients will act rationally to maximize their self-interest. However, patients may not always be the...
The competitive survival of many organizations depends on delivering projects on time and on budget. These firms face decisions concerning how to scale the size of work teams. Larger teams can usually complete tasks more quickly, but the advantages associated with adding workers are often accompanied by various disadvantages (such as the increased...
Functional imaging studies examining the neural correlates of risk have mainly relied on paradigms involving exposure to simple chance gambles and an economic definition of risk as variance in the probability distribution over possible outcomes. However, there is little evidence that choices made during gambling tasks predict naturalistic risk-taki...
The way a choice is presented influences what a decision-maker chooses. This paper outlines the tools available to choice architects, that is anyone who present people with choices. We divide these tools into two categories: those used in structuring the choice task and those used in describing the choice options. Tools for structuring the choice t...
The way a choice is presented influences what a decision-maker chooses.
This paper outlines the tools available to choice architects, that is anyone who present
people with choices. We divide these too
ls into two categories: those used in
structuring the choice task and those used in describing the choice options. Tools
for structuring the choice...
Previous research on capital investment has identified a tendency in multibusiness firms toward cross-subsidization from well-performing to poorly performing divisions, a phenomenon that has previously been attributed to principal-agent conflicts between headquarters and divisions (Stein, 2003). In this paper, we argue that cross-subsidization refl...
Behavioral strategy merges cognitive and social psychology with strategic management theory and practice. Despite much progress, the aims and boundaries of behavioral strategy remain unclear. In this paper we define behavioral strategy and identify the main unsolved problems. We propose a unifying conceptual framework for behavioral strategy and co...
In the early morning hours of June 20, 2011 Ryan Dunn was driving his Porsche 911 GTE up to 140 miles per hour through the Pennsylvania countryside. The car careened over a guardrail and into a wooded area, killing Dunn and a passenger in a fiery crash. A toxicology report later determined that Dunn's blood alcohol level was more than twice the leg...
Economists define risk in terms of the variability of possible outcomes, whereas clinicians and laypeople generally view risk as exposure to possible loss or harm. Neuroeconomic studies using relatively simple behavioral tasks have identified a network of brain regions that respond to economic risk, but these studies have had limited success predic...
An increasing number of organizations" competitive survival depends on delivering high-quality projects on time and on budget. Yet in many industries failed on-time and on-budget delivery rates remain persistently high. We examine one potential source of this problem – mis-estimation of task length due to coordination neglect. Coordination neglect...
In this paper we investigate the claim that decisions from \textit{experience} (in which the features of lotteries are learned through a sampling process) differ from decisions from \textit{description} (in which features of lotteries are explicitly described). We find that the experience-description gap is not as robust as has been previously assu...
Four studies investigated whether activating a social identity can lead group members to choose options that are labeled in words associated with that identity. When political identities were made salient, Republicans (but not Democrats) became more likely to choose the gamble or investment option labeled "conservative." This shift did not occur in...
Many psychology experiments show that individually judged probabilities of the same event can vary depending on the partition of the state space (a framing effect called partition-dependence). We show that these biases transfer to competitive prediction markets in which multiple informed traders are provided economic incentives to bet on their beli...
This chapter highlights the behavioral and neuroscience work on the prospect theory and the neuroscience of behavioral decision-making. Several applications of prospect theory from neuroeconomics to decision analysis to behavioral finance require individual assessment of value and weighting functions. In order to measure the shape of the value and...
Numerous studies have found that likelihood judgment typically exhibits subadditivity in which judged probabilities of events are less than the sum of judged probabilities of constituent events. Whereas traditional accounts of subadditivity attribute this phenomenon to deterministic sources, this paper demonstrates both formally and empirically tha...